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09/21/2010

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Stay Alert: Modifier 57 is still Applicable

Stay Alert: Modifier 57 is still Applicable

Suzanne Leder
M. Phil., CPC, COBGC

Stay Alert: Modifier 57 is still Applicable

Medicare no longer accepts consult codes, but you can still apply modifier 57.

Stay Alert: Modifier 57 is still Applicable

Append modifier 57 to non-consult inpatient E/M code that the documentation supports.

Stay Alert: Modifier 57 is still Applicable

Add the modifier to E/M code to report an EM in addition to the major surgery performed later on the day of the inpatient consult.
(In such cases report 49000 with Modifier 57)

Stay Alert: Modifier 57 is still Applicable

The E/M code you choose depends on circumstances specific to the visit (whether first or second)

Stay Alert: Modifier 57 is still Applicable

For First visit code ± 99221 (Initial hospital care, per day, for the
E/M of a patient, which requires these 3 key components: a detailed history; a detailed examination; and MDM that is straightforward or of low complexity «)

Stay Alert: Modifier 57 is still Applicable

Don¶t forget to append µModifier AI¶ if the ObGyn is the Principal Physician

Stay Alert: Modifier 57 is still Applicable

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